We are currently updating our website, and will have our new version online soon. Please check back later this fall.

Mailing List

Subscribe to the KT Canada mailing list

Login

Welcome

Signup

Once you have signed up, you will receive a confirmation email with your username and password. To activate your account, follow the instructions in the email.

 

KT
Tools

AGREE

AGREE
The AGREE Collaboration. Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument.
Burgers J, Fervers B, Haugh M. 'Guideline appraisal ? an international viewpoint' February 2004.
[External Link]

AGREE is the acronym for "Appraisal of Guidelines Research and Evaluation". The purpose of the AGREE Instrument is

  • To provide a systematic framework for appraising the quality of clinical guidelines
  • To help policymakers decide which guideline to recommend for use in practice
  • To help guideline developers follow a structured and rigorous methodology
  • To help health care providers assess guidelines before adopting recommendations in practice

The AGREE Instrument consists of 23 key items organized in six domains. Each domain is intended to capture a separate dimension of guideline quality.

Six Domains

  1. Scope and purpose (items 1-3) is concerned with;
    • the overall aim of the guideline
    • the specific clinical questions
    • the target patient population
  2. Stakeholder involvement (items 4-7)
    • includes individuals from all relevant professional groups
    • patient's vies and preferences have been sought
    • target users are clearly defined
    • guidelines has been piloted among target users
  3. Rigour of development (items 8-14)
    • systematic methods were used to search for evidence
    • the criteria for selecting the evidence are clearly described
    • the methods used for formulating the recommendations are clearly described
    • the health benefits, side effects and risks have been considered in formulating the recommendations
    • there is an explicit link between the recommendations and the supporting evidence
    • the guideline has been externally reviewed by an expert panel prior to publication
    • a procedure for updating the guideline is provided
  4. Clarity and presentation (items 15-18)
    • the recommendations are specific and unambiguous
    • the different options for management of the conditions are clearly presented
    • key recommendations are easily identifiable
    • the guideline is supported with tools for application
  5. Applicability (items 19-21)
    • the potential organizational barriers in applying the guideline have been discussed
    • the potential costs implications of applying the recommendations have beed considered
    • the guideline presents key review criteria for monitoring and/or audit purposes
  6. Editorial Independence (items 22-23)
    • the guidelines is editorially independent from the funding body
    • conflicts of interest of guideline development members have been recorded

Response Scale

Each item is then rated on a 4-point scale from "Strongly Agree to Strongly Disagree" depending upon the extent to which an item has been fulfilled.

Strongly Agree Strongly Disagree
4 3 2 1

Calculations

Standardized guideline domain scores are calculated by:

  • summing up all the scores of individual items in a domain
  • and by standardizing the total as a percentage of the maximum possible score for that domain

Example:

Item 1 Item 2 Item 3 Total
Appraiser 1 2 3 3 8
Appraiser 2 3 3 3 10
Appraiser 3 2 4 3 9
Appraiser 4 2 3 4 9
Total 9 13 14 36

Max. possible score = 4 (strongly agree) × 3 (items) × 4 (appraisers) = 48
Min. possible score = 1 (strongly disagree) × 3 (items) × 4 (appraisers) = 12

The standardized domain score will be:

(score possible min. - score possible max.) / (score possible min. - score obtained)
= (36 - 12) / (48 - 12)
= 24 / 36
= 0.67 × 100
= 67%